Background and Purpose: We report our initial experience with a prototype ureteroscope having the smallest tip diameter and shaft with an offset eyepiece for the treatment of ureteral stones.
Patients and Methods: A series of 21 male and 4 female patients between the ages of 1.5 and 57 years underwent treatment with the new ureteroscope for stones in the lower (24) and middle (1) ureter. All four of the children were boys. All patients were operated on by a single urologist. Patient sex, age, side, location and size of stone, type of anesthesia, requirement for a guidewire, use of stent, requirement for ureteral dilatation, operative time, type of intracorporeal lithotripsy used if any, type of stone-grasping device used, success rate, length of hospital stay, and complications were recorded.
Results: None of the patients required ureteral dilatation, and a guidewire was used in only three patients. Eight patients were operated on with instillation of 2% lidocaine gel alone, while another five patients required intravenous pentazocine and midazolam. Eight patients were operated on with monitored anesthesia care under propofol and one under ketamine. Three patients required general anesthesia. A double-J stent was not required in 15 patients. The success rate was 100%, and complications were minor.
Conclusion: The new ureteroscope can treat the majority of lower-ureteral stones of up to 1.2 cm even in male patients under lidocaine gel with or without intravenous sedation or monitored anesthesia care. These patients can be treated as day-care cases. None of the patients required ureteral dilatation, and stent is now being omitted in most patients. All children were treated in one session.
